Joint Entrance Examination (Main) - 2017

CENTRAL BOARD OF SECONDARY EDUCATION

ACKNOWLEDGEMENT PAGE

Application No. 71036616

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CANDIDATES ARE REQUESTED TO RETAIN THE PRINTOUT OF ACKNOWLEDGEMENT PAGE FOR FUTURE REFERENCE.

Personal Details
Name: TANMAY DAS Date of Birth: 07/05/1998
Mother's Name: MOUSHUMI DAS CHAUDHURY Category GENERAL
Father's Name: DEVOBROTO DAS Person with Disability(PwD): NO
State of Eligibility: DELHI Percentage of Disability: --
Gender: MALE In case of girl candidate, Are NO
you the only child of your
parents?:
Nationality: INDIAN Place of Residence: URBAN
Passport Number N1655857 You need scribe/reader ?: NO

Examination Details
Applying For:
Mode of Examination:
1st Choice of Exam Centre:
3rd Choice of Exam Centre:
JEE(Main) Paper - 1 (B.E./B.Tech.) Only
PEN AND PAPER BASED EXAMINATION Question Paper Medium: ENGLISH
DELHI/NEW DELHI 2nd Choice of Exam Centre: BAHRAIN
FARIDABAD 4th Choice of Exam Centre: GURGAON

Academic Details
Year of passing class 10th: 2014 Place of 12th class schooling: CITY
Year of Passing or Appearing class 12th/Qualifying Exam: 2016 Type of Institution of Class 12th/Qualifying Exam: PRIVATE
School Board of class 12th/Qualifying Exam: CENTRAL BOARD OF SECONDARY EDUCATION
Name of the Qualifying Examination passed / appearing: The final examination of the 10+2 system, conducted by any recognized central/ state Board, such as Central
Board of Secondary Education, New Delhi; Council for the Indian School Certificate Examinations, New Delhi;
etc.
Percentage of Marks in Class 12th/Qualifying Exam: 95.60 Roll No. of Class 12th/Qualifying Exam: 9100941
Appeared/Appearing for Improvement of Class NO Mode of preperation: SELF STUDY
12th/Qualifying Exam:
Roll Number of Class 12th/Qualifying Examination of
Improvement Examination:
Name and Address of the School/College from where New Millennium School Manama Kingdom of Bahrain
passed/appearing:

Candidate's Mailing Address

Country: India State: DELHI
District: WEST DELHI Address: Flat 123, Gangotri Apartments
Locality: F-Block City/Town/Village: Vikas Puri
Pin Code: 100118 Email Address: tanmay.googly@gmail.com
Mobile Number: 9810073459 Land Line Number: 01128535269

Guardian Details
Qualification Occupation Annual Income
Father's/Guardian's: POST GRADUATE ARCHITECTURE RS. 400001 -500000
Mother's: POST GRADUATE OTHERS (INCLUDING HOUSE WIFE) --

Payment Details
Provider Name: HDFC Bank Payment Gateway Payment Mode: Electronic Payment Gateway
Fee Type: Examination Fee Transaction Amount: 2500 /-
Transaction ID: HHMP5015097321 Date of Transaction: 31-12-2016 20:59:28
DECLARATION
I hereby declare that all the particulars stated in this application form are true to the best of my knowledge and belief. I have read and understood the JEE procedures for both
JEE(Main) and JEE(Advanced) - 2017. I shall abide by the terms and conditions thereon.

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